Chapter 35: Disorders of the Bladder and Lower Urinary Tract Patho Prep U

Disruption of which muscle's contraction can lead to the inability to expel urine from the bladder?

detrusor

A client asks the nurse what the most common sign/symptom of bladder cancer is. Which is the best response by the nurse?

Painless hematuria

A client is admitted with lower urinary tract obstruction and stasis. Which action is the primary intervention?

Urinary catheterization

A 56-year-old client reports urinary incontinence when laughing. The nurse documents this as which type of incontinence?

stress

An older adult client who recently started taking furosemide tells the nurse about now experiencing problems with urine incontinence. Which type of incontinence is this client likely experiencing?

transient

The nurse understands that medications, although very beneficial to clients, can have harmful effects. When working with older adult clients the nurse should recognize that which outcome is a common result of potent, fast-acting diuretics?

urege incontinence

A client tells the nurse that he is experiencing involuntary loss of urine associated with a strong desire to void (urgency). The nurse would recognize this as:

urge incontinence

The nursing instructor who is teaching about incontinence in older adults recognizes a need for further instruction when a student makes which statement?

"Frequency is not a major problem for the elderly."

Following a health promotion class, which statement by a participant demonstrates an accurate understanding of the risk factors for bladder cancer?

"More than ever, I guess it would be worthwhile for me to quit smoking."

The client has just been diagnosed with bladder cancer and asks the nurse what causes it. What would be the nurse's best response to the client?

"The cause is unknown."

In anatomy class, the instructor asks, "Explain how urine is expelled from the bladder during voiding." Which student has given the most accurate response?

"The detrusor muscle contracts down on the urine and the ureteral orifices are forced shut. The external sphincter relaxes as urine moves out of the bladder."

A client has a postvoid residual (PVR) volume of 40 mL. Which information would the nurse teach the client?

"This is a normal value."

A client with bladder cancer asks the nurse, "What did the doctor mean by intravesicular chemotherapy? Am I going to lose all my hair and have to go for treatments over months and months?" The best response would be:

"This is when they put the chemotherapy directly into the bladder to kill any cancer cells."

A client has a postvoid residual (PVR) volume of 250 mL. Which information would the nurse tell the client?

"This value indicates you are having difficulty emptying your bladder."

A client is scheduled for urodynamic studies and asks the nurse, "What exactly is this study going to show related to my voiding problems?" Which nursing response(s) is accurate related to bladder function assessment via urodynamic studies? Select all that apply.

- Pressure changes in the intra-abdominal area - Characteristics of urine flow during voiding - Muscle activity of the external urinary sphincter

The nursing students have learned in class that causes of urinary obstruction and urinary incontinence include which of the following? Select all that apply.

- Structural changes in the bladder - Structural changes in the urethra - Impairment of neurologic control of bladder function

Clients with which medical history will have an increased risk for developing urinary tract infections? Select all that apply.

- Urinary obstruction - Neurogenic disorders - Elderly - Prostate disease

One of the many tests done during urodynamic studies is the sphincter electromyelogram. What does this test study?

Activity of the voluntary muscles of the perineal area

A warehouse worker is experiencing trouble with incontinence, especially when lifting heavy objects. What intervention is most appropriate for this client's needs?

Administration of alpha-adrenergic agonist drugs as ordered

A client who suffers from spastic bladder has been catheterized to promote bladder emptying. Which medication should the nurse plan on the physician ordering to also treat this problem?

Anticholinergic medication

Which type of pharmacologic therapy does the nurse anticipate administering to a client for treatment of a spastic bladder in order to decrease bladder hyperactivity?

Anticholinergic medications

A nursing instructor who is teaching students about urinary incontinence in older adults suggests that an easy and effective way to remember the transient and treatable causes of urinary incontinence is to use which acronym?

DIAPPERS

While studying about the process of urination, the nursing student learns that which muscle is known as the "muscle of micturition"?

Detrusor muscle

An older male comes to the clinic with the chief report of having difficulty voiding. The physician diagnoses him with a lower urinary tract obstruction and stasis. What should the nurse suspect to be the most frequent cause of this client's problem?

Enlargement of prostate gland

A client has just been diagnosed with a neurogenic disorder of the bladder. The nurse caring for him understands that this means that this client could demonstrate which of the following? Select all that apply.

Failure to store urine and Failure to empty urine

A client informs the nurse that she is afraid of developing bladder cancer because her mother had it. She asks the nurse what signs and symptoms are present with this cancer. What does the nurse tell the client is the most common sign of bladder cancer?

Gross hematuria

The nurse is teaching a client about the different treatments used with bladder cancer. Which type of therapy will the nurse describe as being instilled directly into the bladder?

Immunotherapeutic agents

A client reports urinary incontinence, specifically not feeling the urge to urinate until the bladder voids uncontrollably. Client history shows type 1 diabetes of 40+ years and compliance with medication and diet. What is the most likely diagnosis?

Incontinence related to neuropathy causing overactive bladder

A nurse is caring for a client in spinal shock. Which intervention is appropriate in relation to the client's urinary status?

Perform intermittent catheterization

A 67-year-old retired textile worker has developed bladder cancer. His history shows that he smoked for 25 years and is 30.8 lb (14 kg) overweight. What conclusion can the nurse best draw about the etiology and pathophysiology of his bladder cancer?

It is caused by carcinogens that are excreted in the urine and stored in the bladder.

An older adult presents to the primary health care provider's office with a report of bladder leakage. Which assessment correlates with a diagnosis of stress incontinence?

Loss of small amounts of urine when laughing or sneezing

A nurse suspects a client may be experiencing flaccid bladder dysfunction based on 24-hour intake and output. Which diagnostic method is most likely to confirm or rule out whether the client is retaining urine?

Measurement of postvoid residual (PVR) by ultrasound

Urinary obstruction in the lower urinary tract triggers changes to the urinary system to compensate for the obstruction. What is an early change the system makes in its effort to cope with an obstruction?

The stretch receptors in the bladder wall become hypersensitive.

Which clinical manifestations would tell a nurse that a client is having progressive decompensation related to obstruction of urinary outflow?

When tested for residual urine volume, 1400 mL of urine is obtained when client is catheterized.

An older adult with urge incontinence and overactive bladder begins medication treatment with oxybutynin. Which side effects would the nurse include in the education?

dry mouth and constipation are common

Urinary incontinence can be a problem with older adults. One method of treatment is habit training, or bladder training. When using this treatment with an older adult, how frequently should he or she be voiding?

every 2 to 4 hours

The nurse is evaluating client risk for the development of overactive bladder/urge incontinence and determines that which client is at highest risk for this condition?

A client with diabetes mellitus

While studying the GU system the nursing students learn that which sex achieves continence first?

girls

Which assessment indicates to the nurse that a client may have a spastic bladder dysfunction?

incontinence

The older adult client tells the health care provider about experiencing incontinence ever since starting diuretic therapy 2 weeks ago. What term should the provider document in the medical record related to the type of incontinence?

transient